In patients with a Gleason score of > 6 at initial presentation, a bone scan may be indicated regardless of PSA level. However, the value of a bone scan is limited in patients with a Gleason score of < 7 and a PSA level of < 20 ng/mL, per Terris and colleagues. The National Comprehensive Cancer Network (NCCN) guidelines note that multiparametric MRI (mpMRI) outperforms bone scan for detection of bone metastases.
Activity in a bone scan may not be observed until 5 years after micrometastasis has occurred; as such, negative bone scan results do not exclude metastasis.
Chest radiography can be used both as a baseline study and, in select cases, to help reveal rare pulmonary metastases.
Immunoscintigraphy to reveal extraprostatic disease (ie, localized recurrence or lymphatic spread) may yield false-negative results, but the specificity of these studies may be improved when they are combined with CT scanning or single-photon emission CT scanning.
Learn more about imaging studies for the diagnosis of advanced or metastatic prostate cancer.
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Cite this: Daniel S. Schwartz. Fast Five Quiz: Advanced and Metastatic Prostate Cancer Presentation and Diagnosis - Medscape - Jun 27, 2022.